Neurofibromatosis type 1 and pneumoconiosis: A case report on a coincidence.

Neurofibromatosis (NF) is a neurocutaneous syndrome characterized by the development of central or peripheral nervous system tumors. The most common form, known as NF1 or Von Recklinghausen's disease, presents with distinct clinical features, including cutaneous and ocular manifestations, along with various other organ and systemic symptoms. While the lung findings associated with neurofibromatosis lack specificity, they can include parenchymal cysts and bullae formation, primarily in the upper-apical regions. Additionally, progressive fibrotic changes, such as ground-glass areas, consolidations, and paving stone patterns, may manifest in the basal parts of the lungs. In this case report, a case of NF1 diagnosed in adulthood and accompanying pneumoconiosis was discussed as a coincidence.

Endobronchial Tuberculosis in an HIV-positive Case.

INTRODUCTION: Tuberculosis is an opportunist infection that is fatal and most frequently seen in HIV-positive patients due to immunosuppression. Endobronchial lesions can portray symptoms in different ways. Endobronchial Tuberculosis is one of these lesions. CASE REPORT: An HIV-positive, untreated 26-year-old patient with fever, cough, and dyspnea consulted our clinic. In the chest X-ray taken, effusion on the right side and non-homogeneous density increase in the middle and upper lobes, bilaterally more prominent on the right side, were observed. Therefore, the patient underwent bronchoscopy because the CT (computerized tomography) showed mediastinal lymphadenopathy (LAP) and an endobronchial lesion in the left main bronchus. During bronchoscopy, a vegetative endobronchial lesion that causes obstruction in the left main bronchus was monitored. With the help of Pathology and PCR results, endobronchial tuberculosis was diagnosed. CONCLUSION: Even if Acid-alcohol-resistant Bacillus (ARB) is detected negative in patients who stop responding to antimicrobial treatment and are being monitored under radiological scanning, a distinctive diagnosis of endobronchial tuberculosis should be kept in mind while performing bronchoscopy.

Inconsistency and Ambiguity Within the International Classification of Disease 10 Procedure Coding System for Hip Fractures.

BACKGROUND: The International Statistical Classification of Diseases (ICD), 10th Revision Procedure Coding System (PCS) was created to increase the granularity of procedural coding. These codes are entered by hospital coders from information derived from the medical record. Concern exists that this increase in complexity could lead to inaccurate data. METHODS: Medical records and ICD-10-PCS codes were reviewed for operatively treated geriatric hip fractures from January 2016 through February 2019 at a tertiary referral medical center. Definitions for each of the 7-unit figures from the 2022 American Medical Association's ICD-10-PCS official codebook were compared to the medical, operative, and implant records. RESULTS: There were 56% (135 of 241) of PCS codes that had ambiguous, partially incorrect, or frankly incorrect figures within the code. One or more inaccurate figures were noted in 72% (72 of 100) of fractures treated with arthroplasty compared to 44.7% (63 of 141) treated with fixation (P < .01). There was at least 1 frankly incorrect figure contained in 9.5% (23 of 241) of codes. Approach was coded ambiguously for 24.8% (29 of 117) of pertrochanteric fractures. Device/implant codes were partially incorrect in 34.9% (84 of 241) of all hip fracture PCS codes. Hemi and total hip arthroplasties were partially incorrect in 78.4% (58 of 74) and 30.8% (8/26) of device/implant codes, respectively. Significantly more femoral neck (69.4%, 86 of 124) than pertrochanteric fractures (41.9%, 49 of 117) had 1 or more incorrect or partially correct figures (P < .01). CONCLUSION: Despite the increased granularity of ICD-10-PCS codes, the application of this system is inconsistent and often incorrect when applied to hip fracture treatments. The definitions in the PCS system are difficult to be utilized by coders and do not reflect the operation performed.

Evaluation of Anxiety, Depression, and Work-Related Strain Inventory of Code Blue Teams in Turkey During the COVID-19 Pandemic: A Cross-Sectional Survey Study.

OBJECTIVE: This study aimed to evaluate the anxiety, depression, and work-related strain inventory with a cross-sectional electronic questionnaire in code blue teams during the coronavirus disease-2019 pandemic in Turkey. METHODS: A web-based electronic questionnaire was sent to healthcare workers registered in the database of the Turkish Society of Anaesthesiology and Reanimation and the Turkish Resuscitation Council who are in the code blue teams of the hospital where they work. An electronic questionnaire including the hospital anxiety-depression scale and the work-related strain inventory was sent to healthcare professionals. A total of 259 participants who answered the questionnaire were included in the study. RESULTS: It was determined that 41.3% (n=107) of all participants were at risk in terms of anxiety and 64.1% (n=166) were at risk in terms of depression by taking above the threshold value. The mean work-related strain inventory score of the participants was found to be 41.19 ± 6.31. The mean work-related strain inventory values of the participants who received above-threshold values from both the anxiety and depression subscales were also found to be statistically significantly higher than the participants who received below-threshold values (P <.001). CONCLUSION: It was determined that approximately half of the code blue teams were at risk for anxiety and two-thirds of them for depression.

The assessment of risk factors associated with difficult intubation as endocrine, musculoskeletal diseases and intraoral cavity mass: A nested case control study.

BACKGROUND: The predictive factors of difficult airway have been studied to reduce especially the incidence of unanticipating difficult intubation, provide patient safety, and avoid wasting resources. In this study, it was aimed to investigate whether endocrine, musculoskeletal diseases, presence of intraoral mass, and demographic factors have predictive values in the evaluation of difficult air-way as well as frequently used airway assessment tests. METHODS: This study was designed a nested-case control study. After eligibility criterions, totally 1012 patient data were collected, 92 of them were difficult intubation, 920 of them were non-difficult intubation patients (1: 10 ratio). Demographic characteristics of the patients (age, gender), body mass index (BMI), Mallampati, Cormack-Lehane Score (CLS), sternomental distance (SMD), inter incisor gap (IIG), type of surgery, endocrine, musculoskeletal and cardio-pulmonary diseases, and the presence of intraoral mass were compared between groups. RESULTS: Age >52 years, male gender, ASA 3-4, higher BMI, CLS 3-4, Mallampati 3-4, IIG <4 cm, and SMD <10 cm were found statistically significant in terms of difficult intubation. Besides, a statistically significant relationship was found when the groups were compared in the presence of intraoral mass (17.57 times higher, p<0.05), endocrine diseases (3.51 times more common, p<0.05) and musculoskeletal system diseases (4.5 times higher, p<0.05). CONCLUSION: In this study, it was demonstrated that endocrine disorders such as diabetes mellitus and thyroid disorders, musculoskeletal system diseases, and the presence of intraoral cavity mass should be used as predictors for difficult intubation with commonly used airway assessment tests.

Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial.

BACKGROUND AND METHODS: With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single-blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US-guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. RESULTS: In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. CONCLUSIONS: It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

Long-term follow-up results of unfractionated heparin infusion treatment for submassive pulmonary thromboembolism.

OBJECTIVE: Treatment options for submassive pulmonary thromboembolism cases vary depending on the patient's hemodynamic stability, comorbidities, and bleeding risk. The long-term effect of unfractionated heparin treatment on pulmonary hypertension and mortality is unclear. The aim of this study was to investigate the long-term effect of unfractionated heparin treatment on pulmonary thromboembolism. METHODS: This is a cross-sectional study with 22 patients who were diagnosed with submassive pulmonary thromboembolism and followed up at the outpatient clinic between 2016 and 2020 and received unfractionated heparin treatment. RESULTS: Mean pulmonary artery pressure was 53±13.6 mmHg during hospital admission and 42.7±13.4 mmHg at hospital discharge. There was a statistically significant decrease in d-dimer and pulmonary artery pressure levels before and after treatment (p=0.001). At the end of one year, pulmonary artery pressure was considered high in three patients of this study. CONCLUSION: Our study suggests that unfractionated heparin is safe in the treatment of submassive pulmonary thromboembolism in terms of bleeding risk and reduces pulmonary artery pressure.

Quantitative Neuromuscular Monitoring With Train-of-Four Ratio During Elective Surgery: A Prospective, Observational Study.

OBJECTIVES: Postoperative residual neuromuscular block (PRNB) is a serious problem that can cause death after surgery. It was aimed to evaluate the adequacy of neuromuscular block (NMB) during endotracheal intubation and the adequacy of neuromuscular recovery during clinically extubation decision and follow-up with the train-of-four ratio (TOFR) using quantitative monitoring. METHODS: This study has a prospective-observational single-blind study design. A total of 205 adult patients who underwent elective surgery, who had American Society of Anesthesiologists physical statuses I to III, and who were intubated with neuromuscular blocking agent under general anesthesia were included in the study. Train-of-four ratio measurements were provided single-blindly by another anesthesiologist outside the team. The TOFRs were measured at the time of intubation (TOFRind), before reversal agent administration (TOFRpre-rev) and after (TOFRpost-rev), at the time of extubation (TOFRext), and on admission to the postoperative care unit (TOFRPACU). If clinical signs of PRNB appeared, the recovery protocol was applied and then TOFRrec was measured. Postoperative respiratory complications were also evaluated for the first 24 hours after surgery. RESULTS: Endotracheal intubation was performed in 41.5% of the patients (n = 85) without adequate NMB. In 48.8% (n = 100) of the patients, adequate recovery (TOFRext ˂0.9) was not available at the time of extubation. Adequate TOFRPACU rate was found to be significantly higher in those who did not receive additional neuromuscular blocking agent doses (P < 0.001). In the recovery protocol, low-dose sugammadex administered to patients with clinical signs of PRNB significantly increased the TOFRrec rate compared with neostigmine (P ˂ 0.001). The first 24 hours, postoperative respiratory complication rate was 5.4% (n = 11), and the most common hypoxemia was observed. CONCLUSIONS: Approximately half of the patients are intubated without sufficient NMB and extubated without sufficient neuromuscular recovery. This suggests that routine use of quantitative neuromuscular monitoring is necessary for patient safety.

Country-based report: the safety of omalizumab treatment in pregnant patients with asthma

Background/aim: We aimed to report outcomes of pregnant patients with asthma under omalizumab treatment and their infants in our country. Materials and methods: Patients with asthma who received omalizumab for at least 6 months and at least one dose during their pregnancy were retrospectively evaluated using a questionnaire regarding their disease and therapy and the health of their infants. Results: Twenty pregnant patients and their 23 infant's data were analyzed. The mean delivery age was 31.8 ± 7.4 years. They received omalizumab for 28.9 ± 21.8 months. Eight (36.4%) patients showed exacerbation of the disease during pregnancy. Forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) scores at the starting time of omalizumab administration, first month of the pregnancy, and after delivery were 71 ± 18%, 83.4 ± 10.5%, and 80.5 ± 13% (FEV1), and 11.9 ± 4.9, 20.2 ± 2.6, and 20.4 ± 2.2 (ACT), respectively. One patient gave birth to twin infants, two patients to two infants each in different years, and 17 to one infant each. Three (13%) infants had low birth weight and five (21.7%) were born prematurely. No congenital anomalies were detected. Seven (30.4%) infants presented atopic diseases during their life. Conclusion: Omalizumab treatment during pregnancy seems to be safe for both patients and their infants.

Evaluation of Nurses' Approaches to Deteriorating Patients: Survey Study.

OBJECTIVE: Prevention of cardiopulmonary arrest in hospitalised patients is the first and most important step in the life-saving chain. When the condition of the inpatients is worsened, nurses are usually the first to see and evaluate the patient. The aim of this study was to evaluate the attitudes of the nurses working at the Mersin University Hospital, during their routine follow-up to the deteriorating patients and the early warning scoring (EWS) awareness. METHODS: A web-based questionnaire was sent to all nurses working in inpatient services and intensive care units (ICUs) and registered to the hospital database at Mersin University Hospital via e-mail. In the questionnaire, a total of 10 multiple-choice questions were asked to the nurses questioning the unit they worked for, the EWS they used, the complaints they frequently complain about and the applications for the call for help. A total of 146 nurses were included in the study. RESULTS: 43.8% (n » 64) of the participants were in ICU, and 56.1% (n » 82) were in service units. Participants were asked whether they used a special scoring system to recognise the deteriorating patient; 45.2% (n » 66) used the scoring system; and 54.8% (n » 80) reported that they did not use it. Participants working in ICU were more likely to use EWS system. Participants answered the most commonly used scoring system as the Glasgow Coma Scale (n » 40). The participants reported that the most common respiratory distress (n » 135), changes in consciousness (n » 109), palpitations (n » 98) and chest pain (n » 92) occurred in the deteriorating patients. Participants reported that they frequently asked for help from a doctor (80.1%), other nurses (7.5%) and a blue code team (7.5%). CONCLUSION: According to the findings, it is necessary to determine the habits of calling for help and raising awareness for a functional EWS.

The effect of ultrasound-guided serratus anterior plane block in addition to intrathecal morphine on early postoperative period after video-assisted thoracoscopic surgery.

BACKGROUND: The aim of this study was to evaluate the effect of serratus anterior plane block in addition to intrathecal morphine for early postoperative period after video-assisted thoracoscopic surgery on the amount of morphine consumption and the Visual Analog Scale scores. METHODS: This single-blind, randomized-controlled study included a total of 64 patients (39 males, 25 females; mean age: 53.6±17.0 years; range, 20 to 89 years) who were scheduled for video-assisted thoracoscopic surgery in a tertiary hospital between September 2019 and March 2020. Postoperative pain control was achieved with intrathecal morphine 0.6 mg addition to serratus anterior plane block (Group ITM+SAPB) or with only intrathecal morphine (Group ITM) after an induction of anesthesia. The serratus anterior plane block was performed with a single injection of 0.4 mL/kg of 0.25% bupivacaine at the level of fifth rib with ultrasound guidance. Morphine consumption, pain scores, and side effects were recorded in the postoperative period. RESULTS: The mean morphine consumption was significantly lower in the ITM+SAPB group at all time points. Compared to the control group, the Visual Analog Scale-resting and coughing scores were significantly lower in the first 12 h after surgery. Pain scores were significantly higher in the ITM+SAPB group in patients where the trocar was inserted at upper level of the fifth rib than the lower level (3-5 vs. 5-8) during the first 6 h after surgery. CONCLUSION: The use of serratus anterior plane block in addition to intrathecal morphine is a safe and effective way to improve pain control for early postoperative period after video-assisted thoracoscopic surgery. The serratus anterior plane block ensures better analgesia until the peak effect of spinal morphine occurs.

Normal coronary diameters in Turkish population.

BACKGROUND: This study aims to define normal coronary artery diameters of males and females in a sample of Turkish population, compared to Asian-Indian and Western Caucasian populations. METHODS: Angiographic and demographic data of a total of 324 patients (147 males, 177 females; mean age 55.3±10.1 years; range, 32 to 82 years) who underwent elective coronary angiography with angiographically normal coronary arteries between July 2017 and March 2019 were analyzed retrospectively. Proximal diameters of major epicardial coronary arteries were measured using the Axiom Artis software according to edge detection method. All the measurements were adjusted to the body surface area. Unadjusted and adjusted values were compared between genders and with the Asian-Indian and Caucasian population samples. RESULTS: The mean diameters of unadjusted/adjusted left main coronary artery, proximal left anterior descending artery, proximal left circumflex artery, and proximal right coronary artery were 4.5±0.6 mm/2.4±0.4 mm/m2, 3.7±0.5 mm/1.9±0.3 mm/m2, 3.3±0.6 mm/1.7±0.3 mm/m2, and 3.4±0.6 mm/1.8±0.4 mm/m2, respectively. Adjusted left main coronary artery and proximal left circumflex artery were narrower, and unadjusted proximal left anterior descending artery and unadjusted/adjusted proximal right coronary artery were larger in men, compared to women in the Turkish population. Turkish population had similar body surface area and unadjusted/adjusted coronary diameters with Caucasians, whereas adjusted proximal left anterior descending artery was larger in the Turkish population than in Asian-Indians. CONCLUSION: Our study findings on the Turkish population contradict the traditional belief that women have narrower coronary arteries then men. Furthermore, the Turkish population have comparable adjusted/unadjusted coronary diameters with the Western Caucasians, but larger adjusted/unadjusted proximal left anterior descending artery, compared to Asian-Indians. We believe that our findings may contribute to the global data pool of normal coronary diameters and can be utilized in future studies as a database.

Effect of habitual cigarette smoking on the index of cardiac electrophysiological balance in apparently healthy individuals.

BACKGROUND AND AIM: Chronic cigarette smoking has been suggested to portend risk for cardiac arrhythmia generation. Index of cardiac electrophysiological balance (iCEB) is a relatively new ECG parameter indicating balance between ventricular depolarization and repolarization, thereby providing more insight concerning ventricular arrhythmogenesis (VA) than other classical ECG parameters such as QT and corrected QT (QTc) intervals. The present study aimed to assess the status of iCEB in healthy habitual smokers. METHODS: This retrospective study included a total of 80 apparently healthy subjects (45% female, mean age 39.4 ±â€¯8.1 years) with smoking habit and 82 healthy non-smoking subjects (40% female, mean age 37.0 ±â€¯8.6 years) were included between January-September 2019. Demographic, clinical and ECG characteristics were obtained from medical records. iCEB and corrected iCEB values were calculated by dividing respective QT and QTc intervals by QRS duration. RESULTS: Mean PR, QRS and QT intervals were similar between the groups, whereas mean heart rate and QTc interval were greater in the smoker group compared with the non-smokers [(82.0 ±â€¯8.9 bpm vs 77.8 ±â€¯12.4 bpm, respectively, p = 0.016) and (427.05 ±â€¯22.6 msec vs 399.9 ±â€¯12.8 msec, respectively, p < 0.001)]. Subject with smoking habit had greater iCEBc than the controls (5.10 ±â€¯0.49 vs 4.68 ±â€¯0.39, respectively, p < 0.001). However, there was no significant difference in regard of iCEB between the groups (4.37 ±â€¯0.46 vs 4.32 ±â€¯0.42, respectively, p = 0.456). CONCLUSION: iCEBc increases significantly in healthy smokers compared with non-smokers. This may suggest an increased predisposition to Torsades de Pointes-mediated VA in healthy smokers, or in chronic smokers with inherent QT-prolonging genetic variations or those on QT-prolonging drug therapy.

Evaluation of Perioperative Ventilation Strategies: National Survey Study.

OBJECTIVE: Lung injury can develop in the perioperative period due to ventilation management techniques. Thus, the attitude of anaesthetists on protective ventilation (PV) practice comes into question. In our study, we aimed to evaluate the perioperative ventilation practice of anaesthetists and trainees on anaesthesiology by a survey study. METHODS: Survey form was sent to all doctors registered to TARD via electronic mail. The participants were asked questions involving PV parameters such as low tidal volume (TV) according to ideal body weight (BW), positive end-expiratory pressure (PEEP), FiO2 use and recruitment manoeuvre (RM) application. In total, 411 doctors who answered the survey were included to the study. Application rates of PV parameters and causes were compared within the answers obtained. P<0.05 was accepted statistically significant. RESULTS: PV was practised by 19.4% of the participants. Those who preferred low TV used ideal BW more frequently (p<0.001). PEEP of 4-6 cm H2O was commonly used (p<0.001). The participants mostly preferred FiO2 of 1.0 (60.4%), and application rate of RM was found to be 17.2%. The use of all PV parameters was detected to be higher among instructors than among other groups. CONCLUSION: In our study, application ratio of PV with all its parameters was found to be lower. Among the parameters, while low TV according to ideal BW and PEEP were applied at higher ratios, the use of RM and low oxygen percentage were applied less frequently. While PV was found to be useful in terms of perioperative ventilation strategies, low practice rates may result from habits besides lack of knowledge and experience; comprehensive and quality education studies are needed to overcome this.

Association between blood pressure, inflammation and spirometry parameters in chronic obstructive pulmonary disease.

BACKGROUND/AIMS: Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction. METHODS: We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups. RESULTS: In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV1%). Diastolic blood pressure was associated with pH and HCO3 levels. The mean night time, day time pulse pressures and 24- hour pulse per minute values were also associated with all the parameters except FEV1%. CONCLUSION: In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers.

OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study.

OBJECTIVES: The objective of the study was to compare the efficacy of an oscillating positive expiratory device and the active cycle of breathing techniques (ACBT) in patients with bronchiectasis. MATERIALS AND METHODS: A home-based study that lasted for 4 weeks was designed to compare the oscillating physiotherapy device Flutter® and the ACBT in 40 patients, who were randomly assigned into two groups containing 20 patients each. The effect of the two methods of physiotherapy on sputum production, pulmonary functions, and the quality of life was compared. RESULTS: The results of the present study indicate that both the methods were associated with a reduced number of patients complaining of cough and fatigue and increased sputum production (p=0.000, p=0.004, and p=0.002, respectively). In addition, statistically significant reductions were determined by the Medical Research Council and Borg Dyspnea scores (p=0.001 and 0.002, respectively). The Flutter® device caused a more significant effect on the perception of dyspnea. Overall, there was an improvement in the physical sub-scale of the Short Form (SF)-36 Quality of Life Questionnaire scores of 36 patients who completed the study (p=0.001). During the physiotherapy period, no changes in pulmonary functions were observed. Exacerbations were recorded in 3 patients in the ACBT group and in 1 patient in the Flutter® group. CONCLUSION: The Flutter® device and ACBT represent effective home-based physiotherapeutic methods. The Flutter® device appears to be more effective with regard to sputum production.